Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Naira Aghajanyan, Staff. Rebeka Durgaryan, Administrator was contacted by staff and she arrived 10 minutes later to conduct the visit. The reason for today's visit was provided.

The home is a single storey family home consisting of a living room, dining room, a kitchen, a den, an office, 5 bedrooms and 3 full bathrooms of which one is designated for staff use.. Four bedrooms are designated for resident use and the bedroom by the front door is for staff use. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN resident. Bedroom #2, located in the back right hand corner, is designated for Bedridden use.

All 12 domains of the CARE Inspection Tool was reviewed on today's visit, six (6) resident files and 6 staff files were reviewed and a tour of the physical plant was conducted, inside and outside. The following were observed:

The living room, dining room, den and kitchen were all equipped with the appropriate furnishings and equipment. The water temperature tested in the kitchen read 137.4 degrees Fahrenheit.

Bedroom #1 and bedroom #2 were observed with 2 hospital beds, 2 night stands, 2 chairs, 2 lamps, 2 small chest of drawers and a built in closet. Bedroom #2 has 1 shared dresser.

Bedroom #3 and bedroom #4 were observed with 1 hospital bed, 1 night stand, 1 lamp, 1 dresser, a